Carcinoma lung on the background of ILD - CT

Radiograph of 65 year old male patient who is know case of Usual interstitial pneumonitis (UIP) showing bilateral reticular shadows (arrow heads) with well deifned soft tissue density lesion in the left upper lobe perihiar region. 

CT scan at the level of arch of aorta showing heterogenpusly enhancing lesion in the left upper lobe (arrow) and HRCT lung window showing reticular shadows with honey combing (arrow head). CT guided biopsy of the lesion showed non small cell bronchogenic carcinoma. 

Discussion:

Studies have showed that the Usual interstitial pneumonia (UIP), or idiopathic pulmonary fibrosis (IPF), has been considered to be associated with a high risk for lung carcinoma. It is more common in males probably due to smoking. 

The nodule or mass in a patient with UIP should be evaluated properly. CT and CT-PET are the preferred modalities. If requred CT guidded biopsy has to be done to confirm the diagnosis. As small as 1 cm nodule can be sampled with CT guidence. 

Most of the carcinomas will be peripheral in patients with UIP unlike our case. The diseased lung (UIP) surrounding the nodule/mass can cause pneumothorax during biopsy should be taken care meticulously.

Tracheal trifurcation-CT and Virtual bronchoscopy

A 2 year old boy admitted with recurrent respiratory tract infection for evaluation of active chest infection. Multislice computed tomography of chest was done which showed no evidence of active infection, but there was an incidental finding of tracheal trifurcation (volume rendered reconstruction showed two bronchi [long white arrow and arrow head] arising from the trachea on right side and left main bronchus [short arrow], and on virtual bronchoscopy inset two bronchi [long white arrow and arrow head] and left main bronchus [short arrow]).

Discussion:

Tracheal trifurcation is an extremely rare anomaly in which the trachea divides into three main stem bronchi rather than two, with two main bronchi supplying the right lung and one supplying the left lung.

Patients usually are asymptomatic and it is detected incidentally on imaging. Some patients may present with recurrent respiratory tract infection and may progress to bronchiectasis and chronic bronchitis.

It is important to identify this anatomical variant in patients requiring tracheal intubation.

Exophytic hydatid cyst of liver- CT

Exophytic hydtid cyst which is dumbell shaped and causing portal vein obstruction resulting in atrophy of right lobe of liver is unusual.

Other things about liver hydatid cyst are explained in my previous blog...Click on the following link..

http://manju-imagingxpert.blogspot.com/2009/08/hydatid-cyst-of-liver.html